重复经颅磁刺激对注意缺陷多动障碍患儿的 疗效：基于范德比尔特量表的随机假刺激对 照试验

Efficacy of Repetitive Transcranial Magnetic Stimulation in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Sham-Controlled Trial Based on the Vanderbilt ADHD Diagnostic Rating Scale

摘要: 背景：注意缺陷多动障碍(ADHD)是儿童期最常见的神经发育障碍之一。重复经颅磁刺激(rTMS)作为一种无创脑刺激技术，近年来在ADHD治疗中展现出潜力，但高质量临床证据仍然有限。目的：采用随机假刺激对照试验设计，以范德比尔特ADHD诊断父母评定量表为主要评估工具，评价高频rTMS对ADHD患儿的临床疗效。方法：将80例符合DSM-5诊断标准的ADHD患儿(年龄7~14岁)随机分为rTMS组(n = 40)和假刺激组(n = 40)。两组均接受4周治疗(20次，每周5次)。rTMS组接受10 Hz高频刺激，靶点为右侧背外侧前额叶皮层(DLPFC)；假刺激组采用相同参数的假刺激线圈。在基线(T0)、治疗结束后即刻(T1)及随访1个月(T2)三个时间点，采用范德比尔特ADHD诊断父母评定量表(VADPRS)评估ADHD核心症状，并记录不良事件。结果：rTMS组完成治疗39例(脱落率2.5%)，假刺激组完成40例(脱落率0%)。治疗结束后，rTMS组VADPRS注意缺陷分量表得分从基线(17.38 ± 2.31)降至(12.65 ± 2.14)，下降幅度显著大于假刺激组(从17.52 ± 2.28降至15.88 ± 2.36)，组间差异有统计学意义(F = 12.47, P < 0.001)。rTMS组多动/冲动分量表得分从(12.84 ± 2.56)降至(9.71 ± 2.38)，假刺激组从(12.96 ± 2.61)降至(11.65 ± 2.50) (F = 8.93, P = 0.003)。总分量表得分的组间差异同样显著(F = 15.21, P < 0.001)。随访1个月时，rTMS组的疗效基本维持。两组不良事件发生率差异无统计学意义(P > 0.05)，最常见的不良事件为短暂性头皮不适。结论：高频rTMS刺激右侧DLPFC可有效减轻ADHD患儿的注意缺陷和多动/冲动核心症状，疗效在治疗结束后可维持至少1个月。rTMS在儿童ADHD中具有良好的耐受性和安全性。

Abstract: Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, has shown promise in the treatment of ADHD in recent years, yet high-quality clinical evidence remains limited. Objective: To evaluate the clinical efficacy of high-frequency rTMS in children with ADHD using the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) as the primary outcome measure in a randomized sham-controlled trial design. Methods: A total of 80 children diagnosed with ADHD according to DSM-5 criteria (aged 7~14 years) were randomly assigned to either the rTMS group (n = 40) or the sham stimulation group (n = 40). Both groups received 20 sessions of intervention over 4 weeks (5 sessions per week). The rTMS group received 10 Hz high-frequency stimulation targeting the right dorsolateral prefrontal cortex (DLPFC), while the sham group received sham stimulation with identical parameters using a sham coil. The Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) was administered at baseline (T0), immediately after treatment completion (T1), and at 1‑month follow-up (T2) to assess core ADHD symptoms. Adverse events were recorded throughout the study. Results: In the rTMS group, 39 participants completed the treatment (dropout rate 2.5%), while 40 participants completed treatment in the sham group (dropout rate 0%). At post-treatment, the VADPRS inattention subscale score in the rTMS group decreased significantly from baseline (17.38 ± 2.31) to (12.65 ± 2.14), with a significantly greater reduction compared with the sham group (from 17.52 ± 2.28 to 15.88 ± 2.36; F = 12.47, P < 0.001). The hyperactivity/impulsivity subscale score in the rTMS group decreased from (12.84 ± 2.56) to (9.71 ± 2.38), whereas the sham group decreased from (12.96 ± 2.61) to (11.65 ± 2.50) (F = 8.93, P = 0.003). A significant difference was also observed for the total scale score (F = 15.21, P < 0.001). At the 1‑month follow-up, the therapeutic effects in the rTMS group were largely sustained. No significant difference in the incidence of adverse events was found between the two groups (P > 0.05). The most commonly reported adverse event was transient scalp discomfort. Conclusion: High-frequency rTMS targeting the right DLPFC effectively reduces core symptoms of inattention and hyperactivity/impulsivity in children with ADHD, with the therapeutic effects maintained for at least one month post-treatment. rTMS is well tolerated and exhibits a favorable safety profile in pediatric ADHD.